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Supplemental Instruction
Member, Texas Tech University System The Princeton Review - 373 Best Colleges, 2011 Edition

SI Leader and Tutor Application

Personal Information
Local Address
 
    
 
Yes    No
 
Yes    No
 
Yes    No
Employment History
Employer Address
 
    
 
Employer Address
 
    
 
Course Information

List all the courses for which you are capable of providing SI support and/or tutoring.

 
Course Number:    Course Name:    Instructor:   Grade:
 
Course Number:    Course Name:    Instructor:   Grade:
 
Course Number:    Course Name:    Instructor:   Grade:
 
Course Number:    Course Name:    Instructor:   Grade:
 
Course Number:    Course Name:    Instructor:   Grade:
Your experiences
 

Please indicate and briefly discuss your tutoring or peer mentoring experience, if any.

 

Please indicate any past, present and anticipated involvement in other activities or jobs (on or off campus).

 

Please indicate any special skills/qualifications.

References

Indicate the two faculty members who will be submitting reference letters (via e-mail, fax, or by mail):

 
Faculty Name:    Department:   
 
Faculty Name:    Department:   
Consent

I certify that all the information provided by me in connection with my application, whether on this documentor not, is true and complete, and I understand that any misstatement, falsification, or omission of informationshall be grounds for refusal to hire, or if hired, termination.

Additionally, I understand that as a condition of employment, I will be required to provide legal proof of authorization to work in the U.S.

Faculty Reference Information

Faculty may submit the reference information to:

E-mail:

Fax: (325) 942-2776

Mail: Office of SI and ASU Tutor Center
Porter Henderson Library (A307/3rd Floor)
Angelo State University
San Angelo, TX 76909